Telepsychiatry Offers More Accessible Care to Rural Populations

Combining telepsychiatry with in-person visits helped patients in rural Missouri with severe mental illness see a doctor seven days sooner, according to a peer-reviewed study.

The researchers also found that these patients were 34% more likely to have regular follow-up visits. Additionally, 67% of patients in the intervention group had at least one outpatient encounter per month, compared to 50.3% of the control group. Slightly more than 27% of the intervention group received at least one quarter of their visits through telepsychiatry.

“These study findings show that telepsychiatry can be a practical and effective way to help close the gap between rural and urban mental healthcare access,” said Samir Malik, executive vice president and general manager of telepsychiatry at Genoa Healthcare, which helped conduct the study.

Study authors offered hybrid psychiatric care to participants in their attempt to analyze access and health outcomes for rural populations.

The intervention group included 62 Missouri Medicaid patients between the ages of 18 and 64. The patients in the intervention group had a minimum of one telepsychiatry appointment following either a behavioral health or substance use disorder hospitalization or emergency department visit. These patients also underwent in-person outpatient visits with a mental healthcare provider.

The research team used the same Medicaid database to select 180 patients who received only in-person outpatient services.

A total of 242 patients participated in the study.

Initial appointments ran approximately 45 minutes and follow-up appointments spanned 15 to 20 minutes based on patient acuity. A psychiatrist or an advanced nurse practitioner with expertise in mental health disorders conducted both in-person and telepsychiatry visits.

During each telepsychiatry visit, a staff member escorted the patient into a designated room and set up the patient with a HIPAA-compliant video conference browser through which a psychiatrist or practitioner saw the participant.

Researchers measured the number of days between the initial appointment and the first follow-up, psychiatry outpatient visits, emergency department visits and hospital readmissions in the 11-month follow-up period.

Psychiatrists saw patients in the intervention group within 16.4 days, compared to 23.6 days for the in-person-only group.

Researchers found no significant statistical differences between groups for emergency department visits, antipsychotic medication adherence and readmissions. But medication adherence and readmissions showed signs of improvement with hybrid care.

The authors called for more research to determine the long-term impact on cost of care.

“Providing adequate psychiatric care to our rural population is among the top challenges in our behavioral health system because of scarce resources,” said Christy Power, vice president of health services at Preferred Family Healthcare in Hannibal, Missouri. “We’ve only begun to scratch the surface of telepsychiatry as an important tool in the rural mental health provider’s toolbox, but the potential is tremendous.”

The study, titled “Increasing access to rural mental health care using hybrid care that includes telepsychiatry,” can be found in the American Psychological Association’s Journal of Rural Mental Health.

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